Archives of Orthopaedic and Trauma Surgery

, Volume 132, Issue 6, pp 741–750 | Cite as

A novel method of image-based navigation in fracture surgery

  • Michael David KrausEmail author
  • Christoph Dehner
  • Christoph Riepl
  • Hendrik Schöll
  • Florian Gebhard
Orthopaedic Surgery


The treatment of three- and four-part fractures of the humeral head is still controversially discussed. Some advocate primary arthroplasty while the results of primary fixation seem to be superior if no necrosis of the humeral head develops. Today navigation is used in orthopaedic surgery mainly for interventions on the spine, the pelvis and arthroplasty. In trauma surgery it is still rarely used and some technical problems need to be overcome. We report on a case of a three part fracture of the humeral head with mini-open reduction and fixation with image-based guided headless compression screws. For the fixation each screw was placed on the first trial, total radiation time was 60 s. At 12-month follow-up assessment radiographs showed a consolidated fracture, no loosening of the screws and a good glenohumeral articulation. The patient had free function of the shoulder and no pain, the constant score was 98 and the dash score 0. There is no evidence of a necrosis of the humeral head. The literature focuses on shoulder arthroplasty. There are no reports on the use of image-based guidance in shoulder traumatology so far. In conclusion, the described technique allows an accurate fixation of the humeral head fracture as the guidance system (Surgix®) ensures the “first try first hit” screw positioning. The new system was integrated in the workflow and supports the surgeon as an aiming device. The role of navigation system in enhancing minimally invasive surgery of the shoulder should be further explored.


Shoulder trauma Image-based guidance Navigation Humeral head fracture 



The study was approved by the local ethic committee (Nr. 158/09) and by the IRB/IEC Freiburger Ethic-Kommission International (Nr. 09/1385).


  1. 1.
    Atmani H, Merienne F, Fofi D, Trouilloud P (2007) Computer aided surgery system for shoulder prosthesis placement. Comput Aided Surg 12:60–70PubMedGoogle Scholar
  2. 2.
    Biasca N, Schneider TO, Bungartz M (2009) Minimally invasive computer-navigated total knee arthroplasty. Orthop Clin North Am 40:537–563Google Scholar
  3. 3.
    Bicknell RT, DeLude JA, Kedgley AE et al (2007) Early experience with computer-assisted shoulder hemiarthroplasty for fractures of the proximal humerus: development of a novel technique and an in vitro comparison with traditional methods. J Should Elbow Surg 16:S117–S125CrossRefGoogle Scholar
  4. 4.
    Bosch U, Skutek M, Fremerey RW, Tscherne H (1998) Outcome after primary and secondary hemiarthroplasty in elderly patients with fractures of the proximal humerus. J Should Elbow Surg 7:479–484CrossRefGoogle Scholar
  5. 5.
    Briem D, Ruecker AH, Neumann J et al (2011) 3D fluoroscopic navigated reaming of the glenoid for total shoulder arthroplasty (TSA). Comput Aided Surg 16:93–99PubMedCrossRefGoogle Scholar
  6. 6.
    Den HD, Van Lieshout EM, Tuinebreijer WE et al (2010) Primary hemiarthroplasty versus conservative treatment for comminuted fractures of the proximal humerus in the elderly (ProCon): A Multicenter Randomized Controlled trial. BMC Musculoskelet Disord 11:97CrossRefGoogle Scholar
  7. 7.
    Edwards TB, Gartsman GM, O’Connor DP, Sarin VK (2008) Safety and utility of computer-aided shoulder arthroplasty. J Should Elbow Surg 17:503–508CrossRefGoogle Scholar
  8. 8.
    Fankhauser F, Schippinger G, Weber K et al (2003) Cadaveric-biomechanical evaluation of bone-implant construct of proximal humerus fractures (Neer type 3). J Trauma 55:345–349PubMedCrossRefGoogle Scholar
  9. 9.
    Goldman RT, Koval KJ, Cuomo F, Gallagher MA, Zuckerman JD (1995) Functional outcome after humeral head replacement for acute three- and four-part proximal humeral fractures. J Should Elbow Surg 4:81–86CrossRefGoogle Scholar
  10. 10.
    Herman A, Dekel A, Botser IB, Steinberg EL (2009) Computer-assisted surgery for dynamic hip screw, using Surgix, a novel intraoperative guiding system. Int J Med Robot 5:45–50PubMedCrossRefGoogle Scholar
  11. 11.
    Jacob AL, Messmer P, Stock KW et al (1997) Posterior pelvic ring fractures: closed reduction and percutaneous CT-guided sacroiliac screw fixation. Cardiovasc Intervent Radiol 20:285–294PubMedCrossRefGoogle Scholar
  12. 12.
    Kedgley AE, DeLude JA, Drosdowech DS, Johnson JA, Bicknell RT (2008) Humeral head translation during glenohumeral abduction following computer-assisted shoulder hemiarthroplasty. J Bone Joint Surg Br 90:1256–1259PubMedCrossRefGoogle Scholar
  13. 13.
    Kircher J, Wiedemann M, Magosch P, Lichtenberg S, Habermeyer P (2009) Improved accuracy of glenoid positioning in total shoulder arthroplasty with intraoperative navigation: a prospective-randomized clinical study. J Should Elbow Surg 18:515–520CrossRefGoogle Scholar
  14. 14.
    Koulalis D, Kendoff D, Citak M, PF OL, Pearle AD (2011) Freehand versus navigated glenoid anchor positioning in anterior labral repair. Knee Surg Sports Traumatol Arthrosc 19(9):1554–1557Google Scholar
  15. 15.
    Leung KS, Tang N, Cheung LW, Ng E (2010) Image-guided navigation in orthopaedic trauma. J Bone Joint Surg Br 92:1332–1337PubMedCrossRefGoogle Scholar
  16. 16.
    Liebergall M, Ben-David D, Weil Y, Peyser A, Mosheiff R (2006) Computerized navigation for the internal fixation of femoral neck fractures. J Bone Joint Surg Am 88:1748–1754PubMedCrossRefGoogle Scholar
  17. 17.
    Lill H, Josten C (2001) Conservative or operative treatment of humeral head fractures in the elderly? Chirurg 72:1224–1234PubMedCrossRefGoogle Scholar
  18. 18.
    Mosheiff R, Weil Y, Peleg E, Liebergall M (2005) Computerised navigation for closed reduction during femoral intramedullary nailing. Injury 36:866–870PubMedCrossRefGoogle Scholar
  19. 19.
    Neer CS (1970) Displaced proximal humeral fractures. II. Treatment of three-part and four-part displacement. J Bone Joint Surg Am 52:1090–1103PubMedGoogle Scholar
  20. 20.
    Nguyen D, Ferreira LM, Brownhill JR, Faber KJ, Johnson JA (2007) Design and development of a computer assisted glenoid implantation technique for shoulder replacement surgery. Comput Aided Surg 12:152–159PubMedGoogle Scholar
  21. 21.
    Nguyen D, Ferreira LM, Brownhill JR et al (2009) Improved accuracy of computer assisted glenoid implantation in total shoulder arthroplasty: an in vitro randomized controlled trial. J Should Elbow Surg 18:907–914CrossRefGoogle Scholar
  22. 22.
    Schep NW, van Vugt AB (2006) Navigation surgery and fracture treatment. Ned Tijdschr Geneeskd 150:2301–2306PubMedGoogle Scholar
  23. 23.
    Solberg BD, Moon CN, Franco DP, Paiement GD (2009) Surgical treatment of three and four-part proximal humeral fractures. J Bone Joint Surg Am 91:1689–1697PubMedCrossRefGoogle Scholar
  24. 24.
    Sperling JW (2010) Operative treatment of proximal humerus fractures. J Should Elbow Surg 19:479CrossRefGoogle Scholar
  25. 25.
    Suhm N, Jacob LA, Zuna I, Regazzoni P, Messmer P (2003) Fluoroscopy based surgical navitation vs. mechanical guidance system for percutaneous interventions. A controlled prospective study exemplified by distal locking of intramedullary nails. Unfallchirurg 106:921–928PubMedGoogle Scholar
  26. 26.
    Suhm N, Messmer P, Zuna I, Jacob LA, Regazzoni P (2004) Fluoroscopic guidance versus surgical navigation for distal locking of intramedullary implants. A prospective, controlled clinical study. Injury 35:567–574PubMedCrossRefGoogle Scholar
  27. 27.
    Tjardes T, Shafizadeh S, Rixen D et al (2010) Image-guided spine surgery: state of the art and future directions. Eur Spine J 19:25–45PubMedCrossRefGoogle Scholar
  28. 28.
    Tyryshkin K, Mousavi P, Beek M et al (2007) A navigation system for shoulder arthroscopic surgery. Proc Inst Mech Eng H 221:801–812PubMedGoogle Scholar
  29. 29.
    Tyryshkin K, Mousavi P, Pichora DR, Abolmaesumi P (2006) Identification of anatomical landmarks for registration of CT and ultrasound images in computer-assisted shoulder arthroscopy. Conf Proc IEEE Eng Med Biol Soc 1:416–419PubMedGoogle Scholar
  30. 30.
    Verborgt O, De ST, Vanhees M et al (2011) Accuracy of placement of the glenoid component in reversed shoulder arthroplasty with and without navigation. J Should Elbow Surg 20:21–26CrossRefGoogle Scholar
  31. 31.
    Zyto K, Kronberg M, Brostrom LA (1995) Shoulder function after displaced fractures of the proximal humerus. J Should Elbow Surg 4:331–336CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Michael David Kraus
    • 1
    Email author
  • Christoph Dehner
    • 1
  • Christoph Riepl
    • 1
  • Hendrik Schöll
    • 1
  • Florian Gebhard
    • 1
  1. 1.Department of Orthopaedic Trauma, Hand-, Plastic-, and Reconstructive SurgeryUlm University HospitalUlmGermany

Personalised recommendations